Tokyo Medical University Hachioji Medical Center Hachioji-shi, Tokyo, Japan
Background/Case Studies: Transfusion therapy is performed at many facilities in Japan relative to its population. However, it is unclear whether appropriate use is being promoted at individual facilities.
Study
Design/Methods: A national survey on transfusion medicine has been conducted annually, covering all medical institutions that received blood products. One of the themes of the 2021 survey was the appropriate use of blood transfusions, which was addressed through 24 related questions. The survey included items related to transfusion management systems, transfusion therapy implementation systems, and blood product use. There were 9317 eligible facilities in 2021. Factors associated with the appropriate use of blood products were analyzed by univariate and multivariate logistic regression analyses.
Results/Findings: The overall response rate was 51% (82% of hospitals with 300 or more beds, 47% of facilities with less than 300 beds).
The appropriateness of blood transfusions was assessed in the transfusion department at the time of its order in 58% of facilities with 500 or more beds, 45% of those with 300-499 beds, and less than 20% of those with fewer than 300 beds. The promotion of the appropriate use of blood products was included in the protocol of the transfusion management committee in 90% of facilities with 300 or more beds and in 70% of facilities with fewer than 300 beds. However, discussions on appropriate use by the committee occurred in only 70% of the former and 40% of the latter.
Nearly two-thirds of the facilities with fewer than 300 beds did not have a dedicated transfusion department. In facilities with less than 100 beds, about 50% of physicians and laboratory technicians were in responsible for transfusion services, and a similar proportion had transfusion management committees.
Common issues across facilities of all sizes included unclear assignment of responsibility for promoting appropriate use and the absence of formal rules for multidisciplinary involvement. Smaller facilities also cited limited opportunities to discuss appropriate use.
Multivariate logistic regression analysis was used to identify factors associated with facilities that evaluated all transfusions at the time of order in those with more than 300 beds. Significant factors included certification in the Inspection and Accreditation system (odds ratio: 2.05), implementation of transfusion trigger values in the order system (OR: 2.45), and collaboration with the surgical department (OR: 1.88).
Conclusions: These findings suggested that implementing transfusion trigger values in the ordering system and utilizing an external audit system are crucial to promote the appropriate use of blood products. It was also necessary to provide opportunities for smaller facilities to discuss appropriate use through regional collaboration and interaction with community-based professionals.
